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<a href="/topics//Michael_Mauti">Michael Mauti</a> has to laugh at what seems to be his good fortune. 
 "If I were lucky," he said with a forced chuckle, "I wouldn't be in this situation in the first place." 
 The former Penn State linebacker has had three ACL reconstructions -- two on his left knee and one on his right -- in the past five years. If not for that, he might have been a second- or third-round pick in April's <a href="/topics//National_Football_League">NFL</a> draft. Because of his ability to return from the surgeries, <a href="/topics//Michael_Mauti">Mauti</a> was selected in the seventh round by the <a href="/topics//Minnesota">Minnesota</a> <a href="/topics//Minnesota_Vikings">Vikings</a> and has a chance to make the team. 
 A chance that might not have existed a few years ago. 
 At one time, a torn anterior cruciate ligament was a career-ending injury in football, but thanks to improvements in surgical procedures and new rehabilitation techniques, players seem to be coming back faster, and sometimes better, than ever. 
 Though it remains a devastating injury, many point to the biggest difference being the improvements in the rehab process, which often begins the very night of the injury. 
 According to Kevin Wilk, a reknowned physical therapist at Champion Sports Medicine in Birmingham, Ala., patients will walk on treadmills submerged in water that alleviate about 25 percent of the body's weight, move on to running on zero-gravity treadmills that use contained air to buoy an athlete like a hovercraft, and eventually graduate to running on solid ground and sports-specific skills. 
 <a href="/topics//Michael_Mauti">Mauti</a> suffered his third ACL injury in November, toward the end of an All-American senior season. Although he was unable to run for scouts at the <a href="/topics//National_Football_League">NFL</a> combine in February, he was in Indianapolis for interviews and other assessments. And of course, he was poked and prodded by just about every team's medical staff. 
 "I had 32 sets of hands on the leg,'' he said, "but everybody was real positive about it.'' 
 <a href="/topics//Adrian_Peterson">Adrian Peterson</a> returned to the <a href="/topics//Minnesota_Vikings">Vikings</a> for the 2012 season, six months after suffering an ACL tear in December 2011 and came within a first down of breaking the <a href="/topics//National_Football_League">NFL</a>'s single-season rushing record. 
 <a href="/topics//South_Carolina">South Carolina</a> running back Marcus Lattimore's knee was mangled in late October (he suffered a torn ACL, MCL and PCL, further complicating matters), but he drew an ovation from scouts at his pro day this spring when he was able to participate in football drills. The 49ers drafted him in the fourth round, even though it was his second ACL injury and he might not play for them in 2013. 
 "It almost used to be that if a running back had it, oh man,'' <a href="/topics//New_York_Jets">Jets</a> coach <a href="/topics//Rex_Ryan">Rex Ryan</a> said in March at the league's owners meetings in Phoenix of the changes in perception regarding ACL injuries. "Just look at the best running back in the league [Peterson] and see it. I think each case is probably a little bit different, and we'll still lean on the doctors. But maybe it's not as big of a deal as it used to be.'' 
 &nbsp; 
 Superhumans 
 The man who might be most responsible for making it seem "not as big of a deal'' insists that it is. 
 Dr. <a href="/topics//James_Andrews">James Andrews</a>, one of the most prominent orthopedic surgeons in the United States, a man whose patients include Peterson, <a href="/topics//Robert_Griffin_III">Robert Griffin III</a> of the Redskins, and Lattimore along with hundreds of other professional athletes, would be one of the most unexpected sources for skepticism when it comes to players returning from ACL injuries. Yet . . . 
 "The last thing I'd want people to be thinking is people are coming back quicker and quicker,'' <a href="/topics//James_Andrews">Andrews</a> said at his facility, the <a href="/topics//James_Andrews">Andrews</a> Institute, in Gulf Breeze, Fla. "The few individuals that you know of who have come back quickly are what I call 'superhuman' athletes . . . There are only a few of those superhuman athletes out there. Their healing potential for some reason is much better than the average patient, but you can't extrapolate their ability to come back from an injury to the average athlete.'' 
 Not even to the average world-class athlete, as in a run-of-the-mill <a href="/topics//National_Football_League">NFL</a> player. 
 "They're all different,'' <a href="/topics//James_Andrews">Andrews</a> said. "There's still a big spectrum in how they heal and how they come back . . . It's hard to predict recovery from an ACL surgery, and to say that we're getting them back quicker than we used to would be false information from my standpoint.'' 
 Many don't come back at all. A 2010 study published in the American Journal of Sports Medicine found that only 63 percent of <a href="/topics//National_Football_League">NFL</a> athletes who had an ACL reconstruction returned to play another game. Roughly two out of three. And two years after ACL surgery, <a href="/topics//James_Andrews">Andrews</a> said, about 55 percent of <a href="/topics//National_Football_League">NFL</a> players are no longer playing in the league. For the majority, an ACL still is pretty synonymous with the end of a career. 
 "That's the real fact,'' <a href="/topics//James_Andrews">Andrews</a> said. "It's not a good injury to have regardless of how good a job we do.'' 
 &nbsp; 
 The schedulemaker 
 The actual procedure for reconstructing an ACL takes less than an hour. The rest of it happens outside the operating room in lonely gyms and training rooms, where the knee is brought back to health. It takes only about four weeks for the bones that hold the new ACL in place to heal. It takes much, much longer for the muscles around the ligament -- the quadriceps, the hamstring, even the hip -- to strengthen enough to protect that new ACL properly. 
 That's where someone like Wilk comes in. Wilk is one of the foremost physical therapists in the country and has worked hand-in-hand with <a href="/topics//James_Andrews">Andrews</a> for years. When prominent players coming back from ACL surgery say they are "ahead of schedule'' or "on schedule'' in their recovery, it usually is Wilk who has made that schedule. 
 "For us, ahead of schedule means reaching certain milestones, almost like a road race,'' Wilk said from Champion Sports Medicine. "Sometimes you can start out ahead and fall behind. And then you can start out on track and end up really fast. <a href="/topics//Adrian_Peterson">Adrian Peterson</a>, he started out kind of normal. He didn't really look to me like he was that far ahead. He looked great, don't get me wrong, but it wasn't like he was exceptional.'' 
 Even with zero-gravity treadmills and other innovations, it's still hard to trim time off the rehabilitation. Wilk said the schedule is typically outlined at seven months and one week. That means Peterson, when he returned to football in August after surgery in late December, was actually right on time. 
 So was cornerback <a href="/topics//Darrelle_Revis">Darrelle Revis</a>, who tore his ACL in September and was cleared to return to full activity last month. And Griffin, who had knee surgery in January, conceivably should be ready for the 2013 season. 
 "Peterson didn't come back faster,'' Wilk said. 
 So why the fuss? 
 "He just came back better.'' 
 &nbsp; 
 Smarter muscles 
 Craig Levitz, chief of orthopedic surgery at South <a href="/topics//Nassau_County,_NY">Nassau</a> Community Hospital, sat back in a chair in his <a href="/topics//Lynbrook,_NY">Lynbrook</a> office. With his eyes closed, he reclined, lifted his leg and placed his right foot flat against the wall. Had he undergone a recent ACL reconstruction, he might not have been able to do that simple task. 
 "I can sense where my knee and foot are in space,'' he said. "There are proprioceptors that live in the ACL, but when you tear your ACL, they're gone. The reconstructed ACL has nothing in it.'' 
 Proprioception may be the most important word in returning from an ACL injury. It's the difference between <a href="/topics//Adrian_Peterson">Adrian Peterson</a> and Bulls star point guard <a href="/topics//Derrick_Rose">Derrick Rose</a>, who has yet to play in a game since tearing his ACL more than a year ago. It is the sense of the relative position of neighboring parts of the body and the effort needed to create movement. In other words, it is what allows an athlete to feel like himself again. 
 The body must redevelop those fibers into the new ACL through repetitive activity. 
 "When you tear your ACL and you come back, the game is too fast for you,'' Levitz said. "You're used to seeing a guy [on the field] and your whole body goes that way before you think about it. When you tear your ACL, you have to tell your leg to go that way . . . The muscle loses all its memory when you tear an ACL. You've made a baby again. So you have to teach it.'' 
 The <a href="/topics//Minnesota_Vikings">Vikings</a> did not use Peterson in any preseason games in 2012, but they did allow him to practice in training camp. That helped the muscle memory of those dizzying cuts and bruising bursts to return to his knee. And it took Peterson a little while to get going once the regular season began. He had one game with more than 100 rushing yards in his first six, and that was for 102. In his last 10 games, he ran for fewer than 100 only once. 
 "He did not show that lack of proprioception,'' Levitz said. "Most guys need that one year . . . He very well could have had muscles that were able to re-learn at a rate faster than the average guy's.'' 
 &nbsp; 
 A chance 
 Naturally, a player like <a href="/topics//Michael_Mauti">Mauti</a> draws inspiration from Peterson's 2012 comeback. And now they find themselves teammates in <a href="/topics//Minnesota">Minnesota</a>. Perhaps the <a href="/topics//Minnesota_Vikings">Vikings</a>' firsthand experience with Peterson's injury gave them the confidence to select <a href="/topics//Michael_Mauti">Mauti</a>. After all, Peterson and <a href="/topics//Michael_Mauti">Mauti</a> already have shown they can come back from the injury and play at a high level. 
 "<a href="/topics//National_Football_League">NFL</a> players should expect to be back on the field the next season, without a doubt,'' Levitz said. "It's odd when they're not. NFL players who tear their ACL, there shouldn't be anything to worry about with today's technology.'' 
 That's the biggest advancement in the procedure. It's not a guarantee, but it gives players a chance. They might not make the team. They might not ever regain their original form. But they have a chance to do it, which was not afforded to players of an earlier generation. 
 Players such as Bears great <a href="/topics//Gale_Sayers">Gale Sayers</a>, who came back from an ACL tear to lead the league in rushing, just as Peterson did, but never was the same player and had his career cut short by a second tear. He retired in 1971 at the age of 28. 
 "He was at a disadvantage with that injury compared to today, there's no question about it,'' <a href="/topics//James_Andrews">Andrews</a> said. 
 He folded his hands, looked down, pursed his lips and nodded softly. 
 "I'd have saved his career.''

SPACL26

ACL injuries no longer spelling doom for football careers

mauti peterson collage

While the injury is still a serious one and the rehabilitation can take more than half a year, the actual procedure to reconstruct the anterior cruciate ligament in the knee is relatively simple. It typically takes less than an hour when performed by an experienced orthopedic surgeon. 
 Dr. Craig Levitz, who studied as a fellow under <a href="/topics//James_Andrews">James Andrews</a> in the 1990s and whose orthopedic practice in Lynbrook is one of the busiest in <a href="/topics//New_York_(state)">New York</a> State, offered a step-by-step look at the surgery as it is most often done: using a sliver of the patella tendon to replace the torn ligament. Here, in essence, are the ABCs of an ACL reconstruction. 
 STEP ONE: ANESTHESIA 
 Levitz said most surgeons these days will use regional anesthesia rather than general. A block to the femoral nerve and a block to the sciatic nerve with some sedation gives the surgeon enough of a window to perform the procedure and gives the patient about 24 hours of pain relief. The patient is also given antibiotics to prevent infection. 
 STEP TWO: THE HARVEST 
 A small incision about two to three inches long is made on the front of the knee and a bone block from each end of the patella tendon is harvested. The tendon is under just two layers of skin and away from the infrastructure of the knee, so the risk of developing scar tissue in the actual joint is averted. The standard used to be to take a 25-millimeter bone plug from the patella in order to fix the new tendon in place, but that would lead to increased risk of fractured knee caps. Such an injury curtailed the comeback of Hall of Fame wide receiver <a href="/topics//Jerry_Rice">Jerry Rice</a> in 1997. These days the fixation methods and devices have improved so that a small 10-millimeter bone plug can be used. "You're really just nubbing off the tip of the knee cap," Levitz said. "That tip of the knee cap doesn't even really function." The surgeon uses an oscillating saw to remove the bone blocks and it takes about 10 minutes to complete. 
 STEP THREE: THE CLEANUP 
 The rest of the procedure is generally done arthroscopically. The camera is inserted into the knee and the old ACL needs to be cleaned out. The surgeon removes the remains of the ACL by debrideing it, essentially scraping it off the two bones it used to hold together. A little piece of it is left behind as a marker on each bone so later on the surgeon will know where to drill the hole to attach the new ligament. 
 STEP FOUR: THE NOTCH 
 The most important part of a reconstruction is the placement of the new ACL. To give themselves a more direct sight line to the location of the target area, and also to help prevent re-tearing, a notchplasty is performed. With an arthroscopic burr, the surgeon will "smooth down layer by layer" the V-shaped notch in the back of the femur. This yields a U-shaped area which lacks the sharp edges that can sometimes lead to a re-injury. "Not only have I fixed your ACL, but hopefully I've changed your geometry so you don't re-tear it," Levitz said. And once the notchplasty is completed, in about 10 minutes, "you should be able to see exactly where that ACL belongs on the femur side." 
 STEP FIVE: THE TUNNELS 
 The natural ACL inserts on the back wall of the femoral bone. "We can't get it to stick there, so we have to stick it in the bone," Levitz said. "You're basically trying to drill a perfect hole, one that has about two millimeters of bone on the outside. If you go too deep you blow out the back wall [of the bone]. If you go too far the other way the ACL is more susceptible to re-tearing. If you want to do it perfectly you have to be a millimeter from disaster." A tunnel is first drilled through the top of the tibia bone where those fragments of the original ACL were left behind. The tunnel is 10 millimeters wide and is drilled with an acorn reamer that works similarly to the way tunnels are dug under rivers or through cities. Like putting in golf, most of the time on this portion is spent lining it up. The actual drilling takes about a minute. The femoral tunnel is more difficult and fraught with dangers. Traditionally the knee is flexed and the same reamer is used to go through the tibia and then through the femur. Levitz was taught by <a href="/topics//James_Andrews">Andrews</a> to do it freehand, though, to prevent the new ACL from becoming too vertical and recreating a more natural anatomical position. "He was able to learn and teach his fellows how to feel the drill rub against the back wall [of the femur] so you can glide with your hand along that millimeter and keep it right there," Levitz said of <a href="/topics//James_Andrews">Andrews</a>. "It's a feel thing. That's arguably why his athletes have so much success." The actual drilling of the femoral tunnel takes another minute. 
 STEP SIX: THE INSERT 
 Now there are two tunnels above and below the knee joint that need to be connected with the patella tendon. A pin goes through the tunnel in the tibia, through the femoral tunnel, and out through the skin at the top of the knee. Attached to the pin are two threads, and those are attached to the top of the graft. The graft is fed through the tibial tunnel, through the knee -- "often you need a little movement, a little wiggle, to get it in there," Levitz said -- and the femoral plug goes into the socket and locks in with a compression fit. "You almost have to knock it in so that it's not going anywhere," Levitz said. The ligament is then attached to the femoral side most often with an interference screw made of bioabsorbable plastic or calcium phosphate that does not necessarily secure the bone and tendon but "smushes everything together" and adds to the compression fit. "We're creating interference so the graft won't slide out." Now the surgeon pulls on the tendon from below as hard as he can to make sure it is not going anywhere. The tendon is then tensioned to the proper tautness with the knee flexed at about 30 degrees. The tibial side is secured with an interference screw as well. "At that point, the case is pretty much done," Levitz said. "If everything looks good we'll pull the sutures out, close the graft wound and go home."

SPSURG26.WEB

Six steps of an ACL reconstruction

DR JAMES ANDREWS ACL INJURIES STORY cropped

The first week of rehabilitation in an ACL reconstruction is the most important time frame. 
 "It sets the tone for everything else," said Kevin Wilk, one of the top physical therapists in the country who has worked with some of the biggest names in sports, including the Vikings' <a href="/topics//Adrian_Peterson">Adrian Peterson</a>. "It's critical." 
 Decades ago patients would be in a cast or brace for six weeks post-surgery with their leg slightly bent. Now the key seems to be straightening the knee to full extension as early as possible. With Peterson, Wilk said, he was able to do straight leg raises the day after his surgery. 
 By the second or third week, patients are riding an exercise bike and doing some walking and maybe even very light running in a water-submerged treadmill. That lasts for a few weeks until the athlete is about two months out of surgery. 
 "This is when people start to get rambunctious," Wilk said. "They're feeling good, the leg is good as far as stability, and they wonder why they can't do more than what they're doing. That's usually around the eight-week mark. And that goes for pro athletes as well as the average weekend warrior." 
 This is also the time when the ACL graft -- the new tissue, usually harvested from the patella tendon and connected to the femur and tibia to replace the torn anterior cruciate ligament -- is at its weakest. Between the date of surgery and eight weeks out, Wilk said, the graft will lose about 50 percent of its strength. It has to redevelop blood flow, which takes time. "We have to cool them for the next two to four weeks and gradually ramp them up,'' he said. 
 Swelling in the joint after activity is the most <a href="/topics//Common_(musician)">common</a> setback, and when it occurs the patient is reeled in. 
 The rehab exercises actually have very little to do with the knee itself. Instead, it focuses on the muscles around the knee. The quadriceps in particular become deflated after surgery and the other large muscles in the leg, including the hamstring, and even those in the hip, must be built back up. <a href="/topics//James_Andrews">James Andrews</a>, the orthopedic surgeon, said that for every day of atrophy in the muscles of the leg, it takes an extra week of rehab to recover. 
 There are no universally acknowledged objective guidelines for moving a patient through the rehabilitation process. "It's pure guesswork,'' <a href="/topics//James_Andrews">Andrews</a> said. "Sometimes we guess wrong.'' 
 <a href="/topics//James_Andrews">Andrews</a>, Wilk and others are working to develop objective tests that patients can attempt and pass or fail as they travel the road of rehabilitation. "Those things,'' <a href="/topics//James_Andrews">Andrews</a> said, "are still evolving.'' 
 Generally, though, a patient will be able to run on solid ground without mechanical aid between 12 and 14 weeks after surgery. Every drill is added slowly, first at about 50 percent intensity and then 60-75 percent until finally it is performed at 100 percent. When that occurs varies from patient to patient. Every recovery is a test group of one. If a patient has stuck to the schedule provided by Wilk, though, it should take seven months and one week for a complete recovery. That rarely happens. 
 "Really they're ready when they're ready,'' Wilk said. "We assess and adjust. We're not cooking from a recipe here. We're cooking from taste.''

SPREHAB26.WEB

Complete ACL rehab can take seven months

peterson cropped

Each year, roughly six percent of the athletes who attend the NFL's scouting combine already have a reconstructed ACL. 
 A study published in the American Journal of Sports Medicine in 2009 -- <a href="/topics//New_York_Giants">Giants</a> team physician Dr. <a href="/topics//Russell_Warren">Russell Warren</a> and vice president of medical services Ronnie Barnes were among its six authors -- found there was no difference in length of career or number of games played for players who came into the league with a previous ACL reconstruction. By comparison, those who had another <a href="/topics//Common_(musician)">common</a> knee injury and underwent a meniscectomy had careers that were on average one and half years and 23 games shorter than players without previous surgery. 
 In other words, history of an ACL injury before entering the NFL does not affect the length of a career. The tolerance by NFL front offices has changed drastically regarding players with ACL injuries. 
 "I think modern medicine, the modern technology of getting these guys back on the field is so much better than it has been in the past," <a href="/topics//New_York_Giants">Giants</a> general manager <a href="/topics//Jerry_Reese">Jerry Reese</a> said when asked about the prospects of players such as <a href="/topics//South_Carolina">South Carolina</a> running back Marcus Lattimore and Penn State linebacker <a href="/topics//Michael_Mauti">Michael Mauti</a> in this year's draft. 
 Lattimore's knee was mangled in late October when he tore his ACL, MCL and PCL. <a href="/topics//Michael_Mauti">Mauti</a> suffered his third ACL injury in five years in November, toward the end of an All-America senior season. Both players were selected in the NFL draft last month -- Lattimore in the fourth round (No. 131 overall) by San Francisco, and <a href="/topics//Michael_Mauti">Mauti</a> in the seventh (No. 213 overall) by <a href="/topics//Minnesota">Minnesota</a>. 
 "You see guys with these catastrophic injuries come back much quicker and much more successful than they have done in the past," Reese said. "So we look at it a little different." 
 However, once in the NFL, the tolerance by front offices changes drastically. 
 A 2010 study in the same Journal -- this one by a group of doctors that included Andrews -- found that only 63 percent of athletes who underwent an ACL reconstruction during their NFL career returned to play another game. Most of those who did not return were drafted in the fourth round or lower. 
 But even in the case of an All-Pro talent such as <a href="/topics//New_York_Jets">Jets</a> cornerback <a href="/topics//Darrelle_Revis">Darrelle Revis</a>, there are more questions about his return in 2013 than there likely would have been had he torn his ACL in college or high school. That's one of the reasons the <a href="/topics//New_York_Jets">Jets</a> have had difficulty finding a partner willing to trade for him without seeing him back on the field. <a href="/topics//Minnesota_Vikings">Vikings</a> running back <a href="/topics//Adrian_Peterson">Adrian Peterson</a>, who came back from an ACL tear in 2011 and came within a first down of breaking the NFL's single-season rushing record in 2012, may have set the tone for remarkable ACL comebacks, but he's still the anomaly and not the norm. 
 "All general managers deal with facts and not sound bites or noise," former Colts executive and current <a href="/topics//ESPN">ESPN</a> analyst <a href="/topics//Bill_Polian">Bill Polian</a> said. "The fact is [Revis] is an injured player who has not proven yet that he is what he was before he got hurt."

SPGMS26.WEB

ACL injury not as big a draft day deterrent for NFL teams anymore

reese - cropped

On an early April day, there are surfers and sunbathers and assorted other spring-breakers making their carefree way up and down sunny Gulf Breeze Parkway. They don't seem to realize that behind a thin line of hedges is the <a href="/topics//National_Football_League">NFL</a>'s most popular quarterback -- and its most interesting offseason story -- throwing passes, with his dreadlocks bouncing up and down on each hurl.
<a href="/topics//Robert_Griffin_III">Robert Griffin III</a> rehabbed from an ACL reconstruction at the Andrews Institute, the home base of surgeon <a href="/topics//James_Andrews">James Andrews</a>, who performed the procedure and is overseeing his return to the Redskins.
Griffin probably is the most recognizable of the many professional athletes who come in and out of the facility, but even he is afforded a level of anonymity here.
"For the athletes, it's their one safe haven," said Jamie Nemith, one of the performance consultants at Athlete's Performance, a training center that is part of the Andrews Institute. "We're here to serve you. It's a one-of-a-kind facility."
And it has everything an injured athlete could need. Griffin had his knee surgery performed in a building here during the winter. On that spring day, he spent time in the morning tossing the football on a 50-yard FieldTurf field, did rehab in the training room next door and checked in with doctors for tests in the adjacent building.
Usually, all of those activities would require traveling among various locations, but at the Andrews Institute, it's self-contained. An athlete could go from diagnosis to surgery to recovery to a return to playing without ever leaving the cozy confines of the campus.
"It's a dream come true to have this type of facility, for me," Andrews said. "It's got everything in it. It's sort of like <a href="/topics//Wal-Mart">Wal-Mart</a>. It's one-stop shopping."
Andrews personally does a dozen or so surgeries a week, usually on Tuesdays and Thursdays. And he's always around the facility, so if an athlete has a concern or a setback during rehab, he can go right across the parking lot for an MRI or a face-to-face with Andrews (or one of the 40 other physicians with offices in various specialties -- from neurosurgery to plastic surgery -- at the facility).
"They know they have an entree into me if and when they need it, which is important," Andrews said.
<a href="/topics//New_York_Giants">Giants</a> cornerback <a href="/topics//Terrell_Thomas">Terrell Thomas</a>, who rehabbed his third torn ACL this offseason, spent time at the Andrews Institute and said the ability to see Andrews on a regular basis was a plus. But not the only plus.
"The best thing about that place is it's totally focused on rehabbing athletes and being around other players who are going through the same thing," Thomas said. 
"All the guys who you've seen play over the years you get to connect with, hang out with, play cards and dominos with. It was peaceful down there. Very slow, very country. It was everything I needed to focus on myself.
Compared to his previous rehabilitations, he said, "I felt like I was getting more out of it."
Andrews was based in Birmingham, Ala., for most of his career. In 2007, though, he moved to Gulf Breeze -- just south of <a href="/topics//Pensacola,_FL">Pensacola</a> in northwest Florida -- and opened the 127,000 square-foot Institute.
Though the institute is home to a good number of famous athletes, it has plenty of other patients. Some are members of the military. A football player who is rehabbing a torn ACL might be training next to a soldier who suffered the same injury. Thomas said he was inspired by a woman who had suffered knee injuries in a car crash and was "a fighter."
The institute also features places most athletes don't ever see. At least not yet.
"There's a research and education side of this to develop new tools for treatment and prevention," Andrews said. "We're teaching young orthopedic surgeons who are getting their fellowships in sports medicine for the future."
Andrews wrote a book that was released this winter called "Any Given Monday," which offers prevention tips in more than two dozen youth sports, an attempt to curtail the number of patients he and other orthopedists see.
"We have a lot of emphasis on prevention of injuries in youth sports, which is my big passion during the twilight of my career," Andrews said. "A lot of the work we're doing in the biomechanics lab and research facility is related to prevention. Right now, there's a terrible escalation of injuries in youth sports. Since the year 2000, it's gone up five- to sevenfold, and we're trying to prevent some of that."
For the most part, the Andrews Institute is a place where world-class athletes can go to be diagnosed, fixed and rehabilitated with assembly-line efficiency.
"The energy in this building is amazing," Nemith said. "There is a tremendous amount of healing that goes on here. There's something magical within these walls."

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